Pathology of the orbital apex has traditionally been difficult to manage, with transcranial surgery often the safest option. With the advancement of endonasal endoscopic surgical instruments and techniques, more orbital procedures can be safely performed using this minimally invasive approach, combining the multidisciplinary skills of an experienced orbit surgeon and an otolaryngologist. Dr. Freitag believes the technique provides the most direct route of access to the posteromedial orbit and orbital apex, and it is useful for both intraconal and extraconal lesions. The 2-surgeon, 4-handed technique allows the primary surgeon to use both hands for the delicate orbital apex dissection. The endonasal approach also avoids the risk of collateral damage to the brain and globe.